Healthcare Provider Details

I. General information

NPI: 1154230431
Provider Name (Legal Business Name): ELITE SUPPORT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5051 DELHI RD APT 105
CINCINNATI OH
45238-5699
US

IV. Provider business mailing address

5051 DELHI RD APT 105
CINCINNATI OH
45238-5699
US

V. Phone/Fax

Practice location:
  • Phone: 909-343-3712
  • Fax:
Mailing address:
  • Phone: 909-343-3712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name: MR. JABERRI BRATTON
Title or Position: CEO
Credential: CERTIFIED PEER SUP
Phone: 909-343-3712